Every finding on record at Companion Hospice and Palliative Care of Maricopa, LLC

Observed in Record Review. In 4 of 4 patient records reviewed, the organization had not ensured there was any or a timely and individualized bereavement plan of care in place for discharged to death patients. For example, during review of four closed records the presence of a timely and individualized bereavement care plan was either missing (RR6, RR7 and RR8) was not established near the time of death (RR5). This was confirmed by the Administrator.

Observed in Individual Tracer. In 3 of 3 home visits conducted, the organization had not ensured the medication orders were clear and accurate. For example, during review of the record associated with HV1 the order for Percocet was written in a range from moderate to severe pain without indicating how to establish what constituted a moderate vs severe rating. A second example was upon review of the record associated with HV2 the orders for pain management included three pain medications (tramadol, naprosyn and morphine) without directions of hierarchy of which to use first, second or third. Additionally, in the same record there was an unclear order for gabapentin indicating 1-3 tabs and at hs) these orders also failed to meet the components of a drug order per policy 2-046.2 page 3 number 3. In the third example, during RR5 the patient was also prescribed two different medications for hiccups (chlorpromazine and ativan) without stated hierarchy of which medication should be used first or if they are indicated to be used together. These orders failed to meet the components of a drug order per policy 2-046.2 page 3 number 3. This was confirmed by the Administrator.

Observed in Record Review. In 2 of 8 patient records reviewed, the organization had not ensured the care was provided in accordance with the plan of care. For example in RR4 the CNA had not completed care in the ordered number of visits in wk # 10 in cert, and, in RR7 the CNA had not provided care in the ordered number of visits in week # 5. There were no indications that these missed visits were omitted at the request of the patient or family. This was confirmed by the Team Leader. Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not ensured the care was delivered in accordance with the plan of care. For example in HV2 the CNA had missed one visit in week # 11 . This was confirmed by the DCPS.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not ensured the plan of care written for the Certified Nursing Assistant had current instructions. For example, regarding HV3, the Nurse had not indicated a frequency for changing the sheets on the plan of care that matched her verbalized once a week frequency. Also, related to the same visit the Nurse had not updated the Certified Nursing Assistants plan of care to remove bleeding precautions following discontinuing the blood thinner. This was confirmed by the Team Leader.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not ensured the provision of care in accordance with the nurse written plan of care. For example, during HV3 and review of the associated record it was noted that the Certified Nursing Assistant's plan of care failed to indicate a frequency other than daily for the Aide to change the patient's sheets. This task was not performed during observed HV3. This was confirmed by the Team Leader.

Observed in HR File Review. In 3 of 13 HR files reviewed, the organization had not ensured staff competence was assessed and documented once every three years. For example, during review of HR files, HR11, HR12 and HR13 (contracted Physical Therapy, Occupational Therapy and Speech Therapy) was not assessed for competence within the last three years. This was confirmed by the Administrator.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization had not ensured the medical record was current. For example, during RR4 the Surveyor identified an order for an antibiotic had been written correctly by the physician (including stop date) however, the medication remained on the medication list as an active medication for greater than two months after the ordered stop date. This was confirmed by the Team Leader. Observed in Record Review. In 3 of 11 patient records reviewed, the organization had not ensured the patient's record reflected clarity in patient care. For example, during RR2 the order for the medication Naprosyn was written clearly by the physician but it was not correctly transcribed to the medication profile to include the reason for a as needed medication. This was confirmed by the Administrator. Observed in Record Review. In 2 of 11 patient records reviewed, the organization had not updated the medical record to include Durable Medical Equipment needed to provide medication to the patient. For example, during RR1 the patient had a nebulized medication added to the profile, however, the record failed to indicate a nebulizer was provided to the home to facilitate use of this new medication. This was confirmed by the Team Leader.

Observed in Individual Tracer. In 1 of 3 home visits conducted, the organization had not ensured the medical record was updated with current patient's care, treatment or services. For example during record review of the record associated with HV1 the Surveyor identified that the order for a blood thinner was discontinued one month before the medication was removed from the medication list and the record continued to maintain bleeding precaution status in the nursing and Certified Nursing Assistant care plans. This was confirmed with the Team Leader.